THE RELATIONSHIP BETWEEN BMP-2, INFLAMMATION AND CARDIOVASCULAR HEALTH IN HEMODIALYSIS PATIENTS

 

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https://storage.unitedwebnetwork.com/files/1099/48325f61ec8940fda0cddd9c02510776.pdf
THE RELATIONSHIP BETWEEN BMP-2, INFLAMMATION AND CARDIOVASCULAR HEALTH IN HEMODIALYSIS PATIENTS

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Flaviu
Bob
Flaviu Bob flaviu_bob@yahoo.com University of Medicine and Pharmacy Victor Babes Nephrology TImisoara Romania *
Alexandru Sircuta alexandru.sircuta94@gmail.com University of Medicine and Pharmacy Victor Babes Nephrology Timisoara Romania -
Viviana Ivan ivan.viviana@umft.ro University of Medicine and Pharmacy Victor Babes Cardiology Timisoara Romania -
Iulia Grosu iuliag_13@yahoo.com University of Medicine and Pharmacy Victor Babes Nephrology Timisoara Romania -
LIgia Petrica ligia_petrica@yahoo.co.uk University of Medicine and Pharmacy Victor Babes Nephrology Timisoara Romania -
Oana Schiller oanaleo67@gmail.com BBraun Avitum Center Dialysis Timisoara Romania -
Felix Maralescu felixmihai21@gmail.com University of Medicine and Pharmacy Victor Babes Nephrology Timisoara Romania -
Madalina Bodea maxim_mada@yahoo.com University of Medicine and Pharmacy Victor Babes Nephrology Timisoara Romania -
Adalbert Schiller schiller.adalbert@gmail.com University of Medicine and Pharmacy Victor Babes Nephrology Timisoara Romania -
 
 
 
 
 
 

An important mechanism of cardiovascular disease in patients with chronic kidney disease is related to vascular calcifications, characterized by the deposition of calcium in arterial walls. An important role is played by chronic inflammation, especially in patients undergoing hemodialysis. The role of inflammatory cytokines (TNF-α, IL-6) occurs through different pathways, one of them being the upregulation of osteogenic markers such as bone morphogenic protein-2 (BMP-2).

We studied 58 maintenance HD patients (mean age 60.4 ± 11.7 years, 55% male). Pre-dialysis serum BMP-2, IL-6, TNF-α, IL-1β, C-reactive protein (CRP), markers of chronic kidney disease- mineral bone disease (CKD-MBD), such as serum calcium, serum phosphorus, iPTH and FGF23, were measured. Standard echocardiography assessed mitral valve calcifications, aortic valve calcifications, left ventricular mass (LVM), left ventricular end-diastolic diameter (LVEDD), and right ventricular diameter (RVD). Spearman correlations and multivariate regression explored associations between cytokines and echocardiographic findings.

In our patients we found that mean values for BMP-2 were 642.4 +/- 346.1pg/ml, for IL-6 11.8+/- 20.2 pg/mL, for TNF-α 10.4 +/- 3.2 pg/mL, and for IL-1β was 45.7+/-4.7 pg/ml. We found a statistically significant correlation between inflammation markers IL-6 and TNF-α (R=0.31, p=0.01). Serum BMP-2 levels showed a strong statistically significant correlation with IL-6 (R=0.68, p<0.0001), and also a weak correlation with TNF-α (R=0.26, p=0.05). No correlation of BMP-2 has been found with markers of CKD-MBD. Regarding  ecocardiography, we found correlations with inflammation. IL-6 strongly correlated with LVM (R = 0.63, p < 0.001), RVD (R = 0.53, p < 0.001), while IL-1β correlated with LVEDD (ρ = 0.410; p = 0.004). Regarding BMP-2, we found higher values in patients with aortic valve calcifications (681.02+/- 380.78 vs. 565.26+/-255.93 pg/ml, p=0.2), and with mitral valve calcifications (659.45 +/- 369.60 vs. 582.87 +/- 251.12 pg/ml, p=0.5), however not statistically significant.

There is a strong relationship between BMP-2 and inflammation, expressed especially by IL-6, and also between inflammation and cardiac changes, however the direct relationship between BMP-2 and valvular calcifications could not be proven. This finding may indicate that while BMP-2 participates in early inflammatory and osteogenic signaling, its circulating levels do not necessarily reflect the local tissue processes responsible for calcification. 

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